Q&A

By C. CLAIBORNE RAY

Published: March 29, 2005

Controlling the Urge

Q. Can you train yourself to urinate less frequently by waiting longer to go?

A. Some patients may be told to try a kind of waiting therapy for an overly frequent urge to urinate, but only after other problems are ruled out, notably infections, which can irritate the bladder and decrease its capacity.

The problem, detrusor overactivity (involuntary bladder contractions), involves abrupt urges to urinate even though the bladder may not be full. A complex system of nerve signals coordinates the normal timing of these urges, and breakdowns leading to incontinence are not uncommon, especially in the elderly.

Treatment begins with simple measures like adjusting the timing or the amount of fluid taken in, the Merck Manual of Geriatrics says. Then retraining regimens can be tried.

For example, the manual suggests, a patient who is incontinent every three hours can void every two hours in the daytime and suppress the urge in between, by relaxing, standing or lying down rather than rushing to the toilet, meanwhile doing what are known as Kegel exercises, tensing the muscles in the pelvic floor that cut off urinary flow.

The urge often builds for a minute or so and then recedes, so only a brief period of conscious control may be needed. After a few days, the interval is increased until full control is attained. Drugs to fight bladder contractions may be used as an adjunct to the behavioral therapy. C. CLAIBORNE RAY